Active NPI
Jacquelin Pannebakker
- Physical Therapy Assistant
- Aurora, CO
National Provider Identifier
1922545169
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA.0013703
- Practice address
- 12123 E 16TH Avenue
Aurora, CO 80045 - Phone
- (720) 777-2233
- NPI assigned
- Jan 26, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA.0013703 | CO | Primary |
Addresses
Primary practice location
12123 E 16TH Avenue
Aurora, CO 80045
Mailing address
765 S Lafayette Dr Apt 152
Lafayette, CO 80026-3568
Phone (717) 943-5808
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA.0013703 | CO | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1485388800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485388800000",
"number": "1922545169",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "765 S LAFAYETTE DR APT 152",
"city": "LAFAYETTE",
"state": "CO",
"postal_code": "800263568",
"telephone_number": "717-943-5808"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12123 E 16TH AVENUE",
"city": "AURORA",
"state": "CO",
"postal_code": "80045",
"telephone_number": "720-777-2233"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PANNEBAKKER",
"first_name": "JACQUELIN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-01-26",
"last_updated": "2017-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CO",
"license": "PTA.0013703",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Aurora, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.